1,721,141 research outputs found
Clinical and surgical outcome of endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) in patients with Long-Standing Overt Ventriculomegaly in Adults (LOVA): a systematic review
No full textObjectivesThe optimal surgical procedure for long-standing overt ventriculomegaly in adults (LOVA) remains controversial.MethodsA systematic search of three databases was performed for studies published between January 1999 and March 2022. This systematic review included 12 studies with a total of 318 patients with LOVA surgically treated. PRISMA guidelines were followed.ResultsGait disturbance (74.8%) and headache (59.7%) were the most common clinical presentation. Overall, the rate of postoperative clinical improvement at the last follow-up was 83.6% (95% CI 78.1-86.1). A lower rate of postoperative clinical improvement or halt of progression of presenting symptoms was observed after ETV (211/257 = 82.1% 95% CI 76.2-85.1%) compared with VPS (55/61 = 90.2% 95% CI 80.3-96.1%). Overall, surgical and postoperative complications were reported in 22/297 patients (7.5% 95% CI 4.4-20%) (11 studies). A higher rate of surgical complications was observed in patients treated with VPS (19.7% 95 CI 5.9-46.7%), compared with patients treated with ETV (4.3% 95% CI 2.1-10.9%). The overall rate of second surgery due to failure of first surgical approach (ETV or VPS) was 46/275 (16.7%).DiscussionThis meta-analysis confirmed the efficacy of EVT and VPS in symptomatic patients with LOVA, reporting a roughly 84% of postoperative clinical improvement or halt of progression of symptoms. A higher rate of surgical complications was observed in patients treated with VPS compared with patients treated with ETV. In addition, roughly 18% of patients treated with ETV required a further VPS. These findings should be considered when advising LOVA patients regarding the management of hydrocephalus
Epidural spinal cord compression in Langerhans cell histiocytosis: A case report
No full textLangerhans cell histiocytosis, also known as histiocytosis X, is a rare proliferative disorder of histiocytes. Spinal involvement in the course of Langerhans cell histiocytosis in adult is rare, and epidural location is exceptional. We present a rare case of epidural involvement by Langerhans cell histiocytosis in a 71-year-old man to highlight the importance of considering Langerhans cell histiocytosis in the differential diagnosis of epidural spinal cord compression. © 2013 The Neurosurgical Foundation
The contribution of Carlo Giacomini (1840-1898): the limbus Giacomini and beyond
No full textCarlo Giacomini (1840-1898) was a prominent Italian anatomist, neuroscientist, and professor at the University of Turin. Early in his career, he conducted clinical investigations with the physiologist Angelo Mosso (1846-1910) that culminated in the first recording of brain pulsations in a human subject. Anatomic features named after him include the limbus Giacomini, Giacomini vertebrae, and the vein of Giacomini. Pushing anatomy research to reconsider anthropological studies of the late 19th century, Giacomini strongly refuted the theory connecting criminality to atavistic morphological characteristics. A tireless scientist, he was the first to describe the os odontoideum in 1886 and to suggest that the presence of an incompetent odontoid process may alter the motion of craniovertebral junction, anticipating the concept of spinal instability. In this essay, we highlight the life and scientific contributions of Carlo Giacomini, with emphasis on his contributions to neuroscience
Unsuccessful bypass and trapping of a giant dolichoectatic thrombotic basilar trunk aneurysm. What went wrong?
No full textAneurysms of the basilar trunk represent an exceptional challenge to the neurosurgeon, due to high mortality and surgical morbidity. We present a 69-year-old man with a giant dolichoectatic thrombotic basilar trunk aneurysm (BTA), who underwent right orbitozygomatic craniotomy, posterior cerebral artery (PCA) to right middle cerebral artery (MCA) bypass and trapping of the BTA. Unfortunately, patient died after surgery due to multiple foci of intraparenchymal haemorrhage and thrombosis of a short segment proximal to aneurysm trapped and his body was donated to the hospital, giving us the unique opportunity to compare intraoperative details with anatomical dissection findings, according to our previously published cadaveric neurosurgical research. The great and unique opportunity of this reported case, to learn by watching and watching again what has been done during surgery, to observe small vessels and brainstem perforators and to look at stiches of the bypass, SVG and the position of the clips, permits to refine the theoretical and practical skills for the treatment of complex aneurysms such as that one reported
Survival outcomes in patients with recurrent glioblastoma treated with Laser Interstitial Thermal Therapy (LITT): A systematic review
No full textTo study the role of laser interstitial thermal therapy in recurrent glioblastoma and to assess its effect in the overall survival and in progression-free survival
Anterior cervical corpectomy for cervical spondylotic myelopathy: Reconstruction with expandable cylindrical cage versus iliac crest autograft. A retrospective study
No full textObjectives To compare retrospectively the clinical and radiographic outcomes between cervical reconstruction with expandable cylindrical cage (ECC) and iliac crest autograft after one- or two-level anterior cervical corpectomy for spondylotic myelopathy. Patients and methods Forty-two patients underwent cervical reconstruction with either iliac crest autograft and plating (20 patients) or ECC and plating (22 patients). The average clinical and radiological follow-up period was 77.54 ± 44.28 months (range 14-155 months). The authors compared clinical parameters (Nurick Myelopathy Grade, modified Japanese Orthopedic Association (mJOA) scores), perioperative parameters (hospital stays, complications) and radiological parameters (Cobb's angles of the fused segments and C2-C7 segments, cervical subsidence, fusion rate). Fusion was assessed on flexion-extension X-ray films. Results No significant differences between the two groups were found in demographics, neurological presentation, preoperative sagittal alignment, clinical improvement and length of hospitalization. Patients of the autograft group experienced more postoperative complications, although the difference between the two treatment groups was not statistically significant (15 versus 4.5%, p = 0.232). The fusion rate was 100% in both groups. The average lordotic increase of the segmental angle was significantly greater in the ECC group (p < 0.05). Other radiological parameters were not significantly different in the two groups. Conclusion Cervical reconstruction either with iliac crest autograft and plating or ECC and plating provides good clinical results and similar fusion rates after one- or two-level corpectomy for spondylotic myelopathy. However, the use of ECC obviates donor site complications and provides a more significant increase of lordosis in segmental angle
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